Clinical Study Of The Role Of SSR In The Evaluation Of Bladder Sensory Function

Background and Objective : Bladder sensation plays an important role in regulating the storage and elimination of urine of lower urinary tract (LUT). Sensory function of bladder is actually the subjective sensation from cerebral cortex stimulated by the afferent nervous signal from LUT. Owing to presence of desire to void ahead of schedule by subjective consciousness, namely: subjective consciousness has a vital effect on bladder sensation., which makes more difficult to assess the sensory function of bladder. The abnormality of bladder sensory function leads to the dysfunction of the storing of urine and urination. At present, the evaluation of bladder sensory function is lack of a direct and objective marker. The objective evaluation of bladder sensory function is very significant to the clinical practice. SSR is a reflecting potential of skin after the stimulation which induces nervous current. SSR can be induced by the exogenous and endogenous stimulations, which has been used to evaluate the autonomic nervous function of the patients with peripheral nervous diseases. The recent studies showed that SSR's afferent nervous pathway was in the spinal cord and its central afferent pathway was closely correlated to the central afferent pathway of bladder sensation, which has provided us a new idea on the study of bladder sensory function. This study was to observe the relation between SSR and bladder sensation through the induced SSR by the bladder filling, to find a objective marker objectively reflecting bladder sensation and to distinguish the urinary frequency caused y the subjective desire. Methods: ①Continually detect SSR on 10 healthy adults continually and observe the relation between SSR and subjective micturition desire. Observe the induced SSR by urination when there was no micturition desire and ensure whether afferent impulse or efferent impulse induced SSR. ②Proceed FC and FC-SSR on 15 healthy adults and investigate the correlation between the bladder sensation detected by SSR and that detected by FC. ③Continually detect SSR on 10 patients with increase or decreased bladder sensation, investigate the correlation between SSR and bladder sensation and discuss whether SSR provide the direct evidence for the bladder sensation.④Continually detect SSR, FC, and FC-SSR on 28 patients with urinary frequency and observe SSR when the micturition desire occurred. Then divide the patients into 2 groups according to the SSR and compare the results from FC and FC-SSR between the 2 groups. Results: ①SSR detection demonstrated that the occurrence of FD was accompanied by SSR and as the micturition desire frequently occurred, SSR occurred, too. When SD occurred, SSR's amplitude and frequency increased markedly. After the urination's beginning, SSR disappeared following the weakening of micturition desire. These results demonstrated that bladder filling induced SSR and SSR was closely correlated to the subjective micturition desire. ②The calculation of AUS of SSR demonstrated that on the same examinee, AUC increased markedly when FD was changed to SD and decreased significantly during PU. These results showed that AUC could objectively reflect the change of the bladder sensation on an individual. ③The comparison of AUC between the experimental groups and control group showed that there was no difference which proved that AUC could not be used to reflect the bladder sensation in the different individuals. ④SSR could not be induced when there was no micturition desire, which showed SSR was induced by the afferent impulse from lower urinary tract. ⑤The continual detection of SSR showed that SSR could not be induce in 15 patients of 25 patients, which demonstrated that the micturition desire in these 15 patients wasn't induced by the afferent impulse from lower urinary tract and was subjective. ⑥Compared FDC/MCC detected by FC and that by FC-SSR, which showed that FDC/MCC by FC was lower than that by FC-SSR. The FDC/MCC by FC-SSR was kept stable at 69%. These results showed that SSR could detect bladder sensation avoiding the confounding factors and the results were more objective. The comparison of FDC/MCC between the 2 groups of urinary frequency showed that there was no significant difference between the control and the group without SSR and there was significant difference between the control and the group with SSR. These results showed that the patients with urinary frequency and without SSR had the normal bladder sensation. Conclusions: ①The afferent impulse from lower urinary tract wakes up the subjective micturitiondesire and induces SSR at the same time. ②SSR reflects the bladder sensation objectively, which can be used to evaluate the sensory function of bladder. ③SSR can objectively assess sensory function of bladder. ④SSR is clinically valuable to the differentiation of the mental urinary frequency.